If you are requesting for a chapter, please indicate the chapter's number:

* Your state:

* Your name:

* E-mail address: (You will receive a confirmation of your request at this e-mail address.)

* Your telephone number: (Where you can be reached during business hours.)

Section 2

Please respond to the following statements and upload a sample of your logo in the space provided.

* This new logo is a result of a change in the name of our affiliate.

Yes

No

* We understand that a change in our affiliate's name will require a change in our bylaws. We have submitted our revised bylaws to begin the approval process.

Yes

No

* "SHRM" or the "Society for Human Resource Management" is part of our full legal name or our "also known as" name as outlined in our bylaws.

Yes

No

*

Our logo will be used in conjunction with the SHRM AFFILIATE OF logo and will not be a substitute for the SHRM AFFILIATE OF logo.

*

The SHRM logo or the SHRM AFFILIATE OF logo has not been used in whole or in part in our logo.

*

The following logo is being submitted for approval. We understand that submission does not constitute approval and that a formal approval from SHRM will be sent to the e-mail address indicated in Section 1 of this form.